维持性血液透析患者感染丙型病毒性肝炎150个月随访研究

目的:评价血液透析患者感染丙型肝炎病毒(HCV)的阳转率和危险因素。方法:随访1998年6月～2010年6月在本院透析的血透患者,共纳入2 465例血透患者,采用ELISA法每隔6月在同一实验室检测抗-HCV。结果:1998年6月的抗HCV阳性率为54.7%,每隔半年的阳性率分别为54.7%,53.8%,52.6%,53.0%,51.2%,45.9%,45.5%,48.2%,35.6%,33.7%,33.7%,31.7%,30.4%,28.4%,27.2%,24.5%,20.8%,19.4%,16.6%,14.4%,15.3%,15.2%,12.5%,11.9%和10.0%。在1～150个月随访期间,总计238例患者阳转,随访1～12月者阳转率为4.5%,13～24月者为6.9%,25～48月者为11.9%,49～60月者28.1%,61～72月者35.1%,73～84月者38.6%,85～96月者阳转率46.9%,97～108月者56.3%,109～126月者63.6%,随访至139～150月时,阳转率已高达75%。结论:提示透析环境对HCV传播有影响,可能一方面通过共用透析机,一方面是由于未隔离阳性患者;严格的消毒隔离措施对降低HCV感染和阳转有重要作用。

Follow-up Study of Hepatitis C Virus Infection in Uremic Patients on Maintenance Hemodialysis for 150 Months

Objective:We aimed to delineate the incidence of hepatitis C virus(HCV) infection and HCV seroconversion(SC) in maintenance hemodialysis(HD) patients and to evaluate the effect of isolation measures on HCV in HD unit.Methods:From June 1998 to June 2010,2 465 maintenance HD patients in our HD unit were enrolled in,and the anti-HCV ELISA and HCV nucleic acid testing were consecutively performed every six months.Results:The results showed the prevalence rates of HCV antibody detected consecutively every six months were 54.7%,53.8%,52.6%,53.0%,51.2%,45.9%,45.5% and 48.2% before 2002(without isolation measures) and 35.6%,33.7%,33.7%,31.7%,30.4%,28.4%,27.2%,24.5%,20.8%,19.4%,16.6%,14.4%,15.3%,15.2%,12.5%,11.9% and 10.0% since 2002(with isolation measures),respectively.HCV SC occurred in 238 patients during the follow-up period.1 077 patients were followed for 1~12 months,of which 49(4.5%) had SC for HCV.SC rates increased parallel with the duration of follow up.Of 8 patients followed for 139~150 months,6(75.0%) had SC for HCV.Conclusion:Taken together,we conclude that the dialysis environment is responsible for transmission of HCV either due to common usage of the machines or to the fact that the HCV positive patients are not isolated.The application of isolated hemodialysis of anti-HCV positive patients plus strict supervised universal infection control techniques significantly effect on the long-term prevalence of HCV antibody and SC in HD patients.